Citation NR: 9607138
Decision Date: 03/20/96 Archive Date: 03/26/96
DOCKET NO. 93-10 093 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Louisville,
Kentucky
THE ISSUE
Entitlement to service connection for the cause of the
veteranís death.
REPRESENTATION
Appellant represented by: American Red Cross
ATTORNEY FOR THE BOARD
Debbie A. Riffe, Associate Counsel
INTRODUCTION
The veteran had active service from September 1966 to
September 1968. The veteran died in November 1991, and the
appellant is his widow. This appeal arises from a December
1992 decision of the Louisville, Kentucky Regional Office
(RO) which denied service connection for the cause of the
veteranís death.
CONTENTIONS OF APPELLANT ON APPEAL
The appellant contends that the veteranís service connected
post traumatic stress disorder (PTSD) caused excessive
drinking and that severe alcoholism was a contributing factor
in his death. It is also contended that if the veteranís
alcoholism was not caused by his service in Vietnam, then it
was aggravated by service and the resultant PTSD. The
appellant claims that the veteranís death should be service
connected.
DECISION OF THE BOARD
The Board, in accordance with the provisions of 38 U.S.C.A.
ß 7104 (West 1991 & Supp. 1995), has reviewed and considered
all of the evidence and material of record in the veteran's
claims file. Based on its review of the relevant evidence in
this matter, and for the following reasons and bases, it is
the decision of the Board that the evidence supports the
appellantís claim for entitlement to service connection for
the cause of the veteranís death.
FINDINGS OF FACT
1. All available relevant evidence necessary for an
equitable disposition of the veteranís appeal has been
obtained by the RO.
2. The veteran died in November 1991, at age 50; the
immediate cause of death was probable esophageal varices due
to or as a consequence of alcohol consumption.
3. At the time of the veteranís death, service connection
was in effect for post traumatic stress disorder (PTSD),
evaluated as 30 percent disabling.
4. It is at least as likely as not that PTSD caused the
veteranís chronic alcoholism to become more severe.
CONCLUSION OF LAW
The service connected PTSD contributed substantially or
materially to cause the veteranís death. 38 U.S.C.A.
ßß 1310, 5107 (West 1991 & Supp. 1995); 38 C.F.R. ß 3.312
(1994).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
The appellantís claim is well grounded within the meaning of
38 U.S.C.A. ß 5107(a). That is, the Board finds that she has
presented a claim which is plausible. This test having been
met, the Board must examine the record and determine whether
there is any further obligation to assist the appellant in
the development of that claim. After reviewing the record,
the Board is satisfied that all relevant facts have been
properly developed.
At the time of the veteranís death in November 1991, service
connection was in effect for PTSD, evaluated as 30 percent
disabling. The death certificate lists the immediate cause
of the veteranís death as probable esophageal varices due to
or as a consequence of alcohol consumption. An autopsy was
not performed.
VA hospital records show that the veteran was hospitalized in
each year from 1985 to 1990 and given discharge diagnoses of
alcohol dependence or abuse and PTSD (AXIS I). In a February
1985 hospital summary, the veteran reported that he first
became intoxicated at age 16, that he drank occasionally in
service, and that his drinking got ďout of handĒ in the last
eight months due to nightmares of Vietnam. In a March 1986
hospital summary, the veteran reported drinking due to
insomnia, flashbacks, and suicidal ideation. In a May 1986
hospital report, the veteran reported that alcohol was his
only relief from symptoms relating to PTSD. In a February
1987 discharge summary, the veteran reported that he began to
drink at age 15 and became drunk at age 17. In records dated
in September 1987, the veteran claimed that he used alcohol
for self-medication and to help him sleep. In a January 1988
record, the veteran reported heavy use of alcohol since age
19 and that he used alcohol to self-medicate for relief of
tensions relating to PTSD. Records show that the veteran was
hospitalized from September to October 1989 and that he
reported drinking because of insomnia, flashbacks, and
nightmares of Vietnam. In a March 1990 record, the veteran
reported that he quit working as a truck driver in 1985
because he drank to cover up his PTSD. In records showing
hospitalization from July to August 1990, the veteran
complained that his PTSD had worsened over the last five
years and that he drank due to flashbacks of his Vietnam
experience.
On a December 1986 VA outpatient treatment record, the
veteran reported that he had begun to experience nightmares
and flashbacks about his Vietnam tour of duty following his
discharge from service and that he coped with these
occurrences on his own for a number of years through alcohol
abuse.
In an October 1992 statement, the appellant contended that
the veteranís death was the direct result of his service
connected PTSD.
A January 1996 medical statement of Bruce Cohen, M.D., an
independent medical expert sought by the Board, indicated
that alcoholism frequently accompanies and complicates the
treatment of PTSD. After reviewing the veteranís medical
record, Dr. Cohen stated that he did not find it more likely
than not that the veteranís PTSD ďcausedĒ his chronic
alcoholism. He asserted that, on the other hand, the records
document that the veteran reported on many occasions that he
drank in response to his PTSD symptoms. Given this and the
frequent ďcomorbidityĒ of PTSD and other psychiatric
conditions to include substance dependence, Dr. Cohen opined
that it was at least as likely as not that the veteranís PTSD
caused his chronic alcoholism to become more severe. He
stated that the overall degree to which PTSD exacerbated the
veteranís alcohol dependence could not be determined from the
record, nor could one ascertain to what extent PTSD played a
greater or lesser role than other factors such as genetic
factors, personality factors, occupational instability, or
marital problems.
To establish service connection for the cause of the
veteranís death, the evidence must show that disability
incurred in or aggravated by service either caused or
contributed substantially or materially to cause death. For
a service connected disability to be the cause of death, it
must singly or with some other condition be the immediate or
underlying cause, or be etiologically related. For a service
connected disability to constitute a contributory cause, it
is not sufficient to show that it casually shared in
producing death, but rather, it must be shown that there was
a causal connection. 38 U.S.C.A. ß 1310; 38 C.F.R. ß 3.312.
In this case, the appellant claims that the veteranís service
connected PTSD caused or aggravated his alcoholism, which
eventually was a contributing factor in his death. There is
certainly no medical evidence on file to rebut the conclusion
set forth on the death certificate that alcohol consumption
was a substantial, contributory cause of the veteranís death.
The issue remains as to what role the service connected PTSD
played in the events leading to the veteranís death. The
record contains VA medical records from 1985 to 1990
indicating that the veteran was consistently diagnosed with
alcohol dependence or abuse as well as PTSD. The medical
records are also replete with notations in which the veteran
reported that he first began drinking as a teenager and that
he currently drank in response to symptoms of PTSD.
Moreover, in a January 1996 medical opinion provided at the
request of the Board, Dr. Cohen indicated that while it was
not more likely than not that the veteranís PTSD caused his
chronic alcoholism, it was at least as likely as not that the
PTSD caused his chronic alcoholism to become more severe.
Given this opinion and the VA records, it is reasonable to
conclude that the veteranís PTSD aggravated his preexisting
alcohol and, as such, it is likely that the PTSD played a
significant role in the events leading to death. Therefore,
the Board finds that the evidence supports the appellantís
claim for service connection for the cause of death on the
basis that a service connected disability contributed to
cause death.
ORDER
Entitlement to service connection for the cause of the
veteranís death is granted.
C.W. SYMANSKI
Member, Board of Veterans' Appeals
The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, ß 6, 108 Stat. 740, 741
(1994), permits a proceeding instituted before the Board to
be assigned to an individual member of the Board for a
determination. This proceeding has been assigned to an
individual member of the Board.
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. ß 7266 (West
1991 & Supp. 1995), a decision of the Board of Veterans'
Appeals granting less than the complete benefit, or benefits,
sought on appeal is appealable to the United States Court of
Veterans Appeals within 120 days from the date of mailing of
notice of the decision, provided that a Notice of
Disagreement concerning an issue which was before the Board
was filed with the agency of original jurisdiction on or
after November 18, 1988. Veterans' Judicial Review Act,
Pub. L. No. 100-687, ß 402, 102 Stat. 4105, 4122 (1988). The
date which appears on the face of this decision constitutes
the date of mailing and the copy of this decision which you
have received is your notice of the action taken on your
appeal by the Board of Veterans' Appeals.
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